Respiratory Medications

Front 1

Which bronchodilators stimulate an enzyme (adenyl cyclase) to increase production of cyclic AMP -> bronchodilation?

Back 1

Adrenergics

Front 2

What are some side effects of Adrenergics? (try to name 5)

Back 2

- angina
- tachycardia
- palpitations
- agitation
- anxiety
- insomnia
- seizures
- tremors

Front 3

True or False:
Adrenergics are ok for use in all ages.

Back 3

True (older clients may experience more cardiac stimulation.)

Front 4

For which receptors is Epinephrine an agonist?

Back 4

- B1
- B2

Front 5

What is the drug of choice for bronchospasm?

Back 5

B2 agonist

Front 6

Which bronchodilator is the 1st choice for status asthmaticus (acute asthma?)

Back 6

asthma

Front 7

Concerning short-acting B2 agonists:
- when is the onset of action?
- how long is the duration?

Back 7

- 5 min
- 3-8 hours

Front 8

How are short-acting B2 agonists administered?

Back 8

Metered dose inhalers (MDIs) or Nebulizer treatment

Front 9

The examples below are from which bronchodilator class?
- albuterol (Proventil)
- levalbuterol (Xopenex)

Back 9

Short-acting B2 agonist

Front 10

What route can albuterol be given besides inhalation?

Back 10

PO

Front 11

Which bronchodilator:
- is used to prevent episodes of bronchoconstriction?
- has a slower onset of action?
- has a duration up to 12 hours?

Back 11

Long-acting B2 agonist

Front 12

How long should one wait between MDI puffs?

Back 12

3-5 minutes

Front 13

What rule applies to the frequency of taking long-acting B2 agonist

Back 13

Never take more frequently than q12hr

Front 14

The examples below are from which bronchodilator class?
- formoterol (Foradil)
- salmeterol (Serevent)

Back 14

Long-acting B2 agonist

Front 15

What long-acting B2 agonist is sometimes given to prevent preterm labor?

Back 15

- terubutaline (Brethine)

Front 16

What bronchodilator blocks the action of aCH in bronchial smooth muscle when administered via inhalation?

Back 16

Anticholinergics

Front 17

When are anticholinergics contraindicated?

Back 17

- long-term management of COPD
- bronchoconstriction

Front 18

When are Anticholinergics indicated?

Back 18

- cautious use with narrow-angle glaucoma (increase intraocular pressure)
- BPH (causes urinary retention & anticholinergic prevents contraction of bladder)

Front 19

What are the side effects of Anticholinergics (try to name 5)

Back 19

- dry mouth
- urinary retention
- cough
- nervousness
- nausea
- GI upset
- headache
- dizziness

Front 20

The examples below are from which bronchodilator class?
- ipratropium (Atrovent)
- tiotropium (Spiriva)

Back 20

Anticholinergics

Front 21

Which bronchodilator:
- has an unknown method of action
- is the 2nd line drug in asthma & COPD

Back 21

Xanthines

Front 22

When are Xanthines contraindicated?

Back 22

Emergency treatment of bronchospasm

Front 23

When do side effects to Xanthines usually present?

Back 23

- with elevated serum levels

Front 24

What are some side effects to Xanthines? (try to name 5)

Back 24

- anorexia
- N/V
- agitation
- nervousness
- insomnia
- dysrhythmias
- tonic-clonic seizures

Front 25

The example below are from
which bronchodilator class?
- theophylline (Aminophyilline, Theo-dur)

Back 25

Xanthines

Front 26

Which routes can Xanthine be administered?

Back 26

IV and PO (sustained release far more common)

Front 27

What is the therapeutic range for Xanthines?

Back 27

-serume theophylline 5-15 mcg/mL (narrow range)

Front 28

When should blood be drawn after Xanthine administration?

Back 28

- 1-2 hours after immediate release
- 4 hours after SR

Front 29

How is the dosage for Xanthines calculated?

Back 29

using lean body mass

Front 30

What is the nursing implication concerning administration if GI upset occurs with Xanthine administration?

Back 30

take with a glass of H2O or food

Front 31

What respiratory drugs suppress the inflammatory process and decrease mucus secretion, mucosal edema, repair of damaged epithelium, and reduced airway reactivity? Also increased B2 receptors, enhancing responsiveness to B2 agonists?

Back 31

Corticosteroids

Front 32

When are corticosteroids indicated?

Back 32

- Acute asthma (IV or PO in high/multiple doses)
- Chronic asthma (daily inhalation)

Front 33

What are some contraindications for corticosteroid use?

Back 33

- caution with PUD
- inflammatory bowel disease
- HTN
- CHF
- thromboembolic disorders

Front 34

What are some side effects to corticosteroid use?

Back 34

- fewer with short-term use
- chronic use in children may retard growth & bone mass, and decrease adrenal function
- avoid high doses in children
- oropharyngeal candidiasis, hoarseness (rinse mouth)
- adrenal insufficiency may occur with systemic use or high doses of inhalation
- high dose in elderly increases risk of osteoporosis
- SYSTEMIC ROUTE LIKELY TO CAUSE HYPERGLYCEMIA

Front 35

The following are example of which respiratory drugs:
- PO - prednisone (Deltasone)
- IV - hydrocortisone (Solucortef), methylprednisolone (Solu-medrol)
- Inhalation - fluticasone (Flonase), triamcinolone (Azmacort), beclomethasone (Beconase)

Back 35

Corticosteroids

Front 36

Advair is a mixture of corticosteroids and what B2 agonist?

Back 36

Serevent (given q12 hours)

Front 37

When are Leukotriene modifiers indicated?

Back 37

- long-term management of asthma in adults and children

Front 38

Which Leukotriene modifier is contraindicated in liver disease?

Back 38

zileuton (Zyflo)

(increase LFT with Zyflo)

Front 39

What are some side-effects of Leukotriene modifiers?

Back 39

- HA
- nausea
- diarrhea
- infection

Front 40

The following are examples of which respiratory drugs:
- montelukast (Singulair)
- zileuton (Zyflo)

Back 40

Leukotriene Modifiers

Front 41

Which respiratory drugs prophylactically stop the release of inflammatory mediators when mast cells come in contact with allergens and/or other stimuli?

Back 41

Mast Cell Stabilizers

Front 42

When are Mast Cell Stabilizers indicated?

Back 42

prophylaxis for acute asthma attacks

Front 43

When are Mast Cell Stabilizers contraindicated?

Back 43

- acute bronchospasm
- status asthmaticus
- caution in renal/hepatic impairment

Front 44

What are some side effects of Mast Cell Stabilizers?

Back 44

- dysrhythmias
- hypotension
- chest pain
- dizziness
- convulsions
- anorexia
- N/V
- CNS depression

Front 45

The following are examples of which respiratory drugs:
- cromolyn (Intal)
- nedocromil (Tilade)

Back 45

Mast Cell Stabilizers

Front 46

What route are Mast Cell Stabilizers given?

Back 46

Inhalation

Front 47

Which respiratory drugs block receptors on mast cells and basophils by binding to IgE, ultimately preventing the release of inflammatory mediators?

Back 47

Immunosuppressant Monoclonal Antibodies

Front 48

When are Immunosuppressant Monoclonal Antibodies indicated?

Back 48

allergic asthma unrelieved with corticosteroids

Front 49

What are some side effects of Immunosuppressant Monoclonal Antibodies?

Back 49

- URI
- pharyngitis
- sinusitis

Front 50

The following is an example of which respiratory drug:
- omalizumab (Xolair) [SC route]

Back 50

Immunosuppressant Monoclonal Antibodies

Front 51

Which respiratory drugs is caffeine associated with?

Back 51

Xanthines

Front 52

Which two vaccines are recommended to clients with respiratory difficulties?

Back 52

- flu vaccine
- pneumonia vaccine

Front 53

What is the recommended fluid intake for clients with respiratory difficulty?

Back 53

2-3 quarts/ day

Front 54

At what times should montelukast (Singulair) be administered?

Back 54

Administer in the evening or HS to increase drug concentrations during the night and early morning.

Front 55

What is the first chemical mediator released from basophils & mast cells w/ immune & inflammatory disorders?

Back 55

Histamine

Front 56

Which histamine receptor is located in the smooth muscle in blood vessels, respiratory tract, and GI tract?

Back 56

H1

Front 57

Which respiratory drugs inhibit bronchoconstriction, decrease capillary permeability, decrease salivary & tear formation, and block histamine from acting of target tissues?

Back 57

H1 receptor antagonists (Antihistamine)

Front 58

When are H1 receptor antagonists indicated?

Back 58

- allergic rhinitis
- anaphylaxis
- allergic conjunctivitis
- drug allergies & pseudoallergies
- transfusion premedication
- dermatologic conditions
- motion sickness
- N/V

Front 59

When are H1 receptor antagonists contraindicated?

Back 59

- pregnancy
- narrow-angle glaucoma
- prostatic hypertrophy
- stenosing peptic ulcer
- bladder neck obstruction

Front 60

What is the side effect of First Generation (SEDATING/nonselective) Antihistamines?

Back 60

CNS depression

Front 61

The following are examples of which respiratory drugs?
- diphenhydramine (Benadryl)
- hydroxyzine (Vistaril)
- promethazine (Phenergan)

Back 61

First Generation (SEDATING/nonselective) Antihistamines

Front 62

In addition to PO, both Benadryl and Phenergan can be given IV. When giving Phenergan IV, what amount of saline is used to dilute the drug?

Back 62

10mL saline

Front 63

What property causes the second generation (Nonsedating / selective) antihistamines to produce less sedation than 1st generation?

Back 63

Second Generation Antihistamines do not cross the BBB

Front 64

The following are examples of which respiratory drugs:
- loratadine (Claritin)
- cetirizine (Zyrtec)
- fexofenadine (Allegra)

Back 64

Second Generation Antihistamines

Front 65

Though Second Generation Antihistamines are usually better, what is the downside?

Back 65

they are more expensive

Front 66

What is the MOA of Nasal Decongestants?

Back 66

They constrict arterioles and reduce blood flow to nasal mucosa thereby decreasing nasal congestion.

Front 67

What are some contraindications for Nasal Decongestant use?

Back 67

- HTN
- CAD
- Narrow-angle glaucoma

Front 68

The following are examples of which respiratory drugs:
- pseudoephedrine (Sudafed)
- oxymetazoline (Afrin - nasal spray
- phenylephrine (Neosynephrine)

Back 68

Nasal Decongestants

Front 69

What can occur with extended use of nasal spray? (> 7 days)

Back 69

Rebound nasal congestion

Front 70

Which respiratory drugs depress the cough center in the medulla oblongata, and cough receptors in throat, trachea, and lungs?

Back 70

Antitussives

Front 71

When are antitussives indicated?

Back 71

Dry, hacking, nonproductive cough

Front 72

Which antitussive drug is centrally active (causes drowsiness)?

Back 72

Codeine

Front 73

Which antitussive drug is non-narcotic (non drowsy)?

Back 73

-dextromethorphan (Bentyl DM)

Front 74

What common antitussive drug is given locally?

Back 74

Throat lozenges

Front 75

Which respiratory drugs are given to liquefy secretions?

Back 75

Expectorants

Front 76

The following is an example of which respiratory drug:
- guaifenesin (Robitussin, Mucinex)

Back 76

Expectorants

Front 77

Which respiratory drugs are given via inhalation therapy to liquefy secretions?

Back 77

Mucolytics

Front 78

The following are examples of which respiratory drug:
- sodium chloride & acetylcysteine (Mucomyst)

Back 78

Mucolytics

Front 79

Which respiratory drug is used in the treatment of acetaminophen overdose and in small doses with dye administration?

Back 79

-acetylcysteine (Mucomyst)

Front 80

Which herb and mineral supplements are used to combat colds?

Back 80

- Echinacea
- Zinc gluconate

Front 81

What dose of vitamin C is given to decrease incidence and severity of colds and flu?

Back 81

Doses > 100mg

Front 82

Name three types of bronchodilators, includes short & long-acting.

Back 82

Beta2 agonists, cholinergic antagonists, & methylxanthines

Front 83

What is the purpose of bronchodilators? How is this achieved?

Back 83

Purpose is to increase size of smooth muscle bands by relaxing and opening bronchial and bronchiole airways.

Front 84

A Beta2 Agonist is a ______ _____.

Back 84

sympathomimetic bronchodilator

Front 85

How does a Beta2 Agonist work?

Back 85

The drug binds to Beta2-adrenergic receptors.

Front 86

What is the purpose of a Beta2 Agonist? What does it trigger?

Back 86

The purpose is to increase the level of cyclic adenosine monophosphate (cAMP)which triggers smooth muscle relaxation & dilates bronchial bands of the airway.

Front 87

What effect does the Beta2 agonist cause? Explain why this happens.

Back 87

It also has a dilating effect on peripheral vascular vessels which decreases diastolic BP (Shifts K+ ions from bloodstream to cells which results in a temporary hypokalemia).

Front 88

What are systemic corticosteroids used to treat?

Why should systemic corticosteroids be taken w/food?

To decresase GI ulceration.

Name two important side effects to be aware of and monitor for.

immunosuppression & increased blood glucose levels (hyperglycemia)

What is the most common oral systemic corticosteroid agent?

Prednisone

What should client education about systemic corticosteroids include?

Never abruptly discontinue drug, slowly taper only; Need medical alert bracelet; Report weight gain of 5 pounds in 1 week; Take w/food.

Name a new category of inhaled agents?

Inhaled Anti-inflammatory agents

How do inhaled anti-inflammatory agents work?

Inhibit release of inflammatory mediators from respiratory cells & WBCs which stabilizes the mast cell wall.

What do inhaled anti-inflammatory agents effect?

decrease lung nerve stimulation.

What are inhaled anti-inflammatory agents used for?

Prevents asthma events, but not useful during an asthmatic attack.

How long before inhaled anti-inflammatory agents are effective?

4 weeks

What should a client do if symptoms worsen?

discontinue medication

Name the primary agent in the inhaled anti-inflammatory agent class.

Nedocromil (Tilade)

How do mast cell stabilizers prevent asthma attacks?

By preventing mast cell membranes from opening when and allergen binds to the IgE molecule (provides and anti-inflammatory effect)

When are mast cell stabilizers not useful?

during an asthmatic attack.

Mast cell stabilizers used regularly for a _____ _____.

prophylactic effect

How are mast cell stabilizers used to relieve seasonal allergy attacks?

Start tx 3-4 weeks before the season.

What is the most common mast cell stabilizer agent?

Cromolyn Sodium (Intal)

What is the MOA of Monoclonal Antibodies?

Binds to IgE receptor sites on mast cells & basophils thus preventing allergens from triggering release of mediators from these cells.

When/How are monoclonal antibodies effective?

Will prevent attack, but not useful during asthmatic attack.

How are monoclonal antibodies administered?

Administered subcutaneously. Roll vial gently since drug is slow to dissolve.

What is the most common monoclonal antibody agent?
Omalizumab (Xolair)

What do Leukotriene Receptor Agonists do?

Block leukotriene production during inflammation, thus preventing asthma symptoms

What are some side effects of leukotriene receptor agonists?

headache; GI symptoms, dizziness; & insomnia

What is an priority intervention with a client on a leukotriene receptor agonist?

Monitor liver enzymes w/these agents.

Name some leukotriene receptor agonists.

zileuton (Zyflo); zafirlukast (Accolate); montelkast (Singular)

What does zileuton (Zyflo) do?

prevents leukotriene synthesis, but increases plasma concentration of theophylline (Need to decrease theophylline dose)

What do zafirlukast (Accolate) & montelukast (Singular) do?

Block the leukotriene receptor.

If the client is taking aspirin, which leukotriene receptor agonist dosage should be changed? Will it be increased or decreased?

Zafirludast (Accolate) dose should be decreased.

What do mucolytics do?

thin thick, tenacious mucus secretions

Name the commonly used aerosol mucolytics.

acetylcysteine (mucosil, mucomyst); dornase alfa (pulmozyme)

Name an oral systemic mucolytic agent.

guaifenesin.

During mucolytic therapy, what
must a client be taught to do?

increase fluid intake

What are antitubercular medication used to treat?

All forms of infection from mycobacterium.

How long does antitubercular treatment last?

Therapy is usually for 6 months or longer until 3 negative sputum cultures for TB occur.

What is antitubercular drug therapy dependent on?

Drug therapy is dependent upon drug-susceptibility tests.

What is the cornerstone of drug regimen for antitubercular therapy?

Client education

How can the general public be protected from TB spread?

Strict client compliance.

How is the noncompliant TB client managed?

Mandate to participate in directly observed therapy (DOT) provide by health clinics.

How is the emergence of drug resistant TB organisms reduced?

By combination therapy to maximize destruction of the organism as rapidly as possible.

Name the primary (first-line) antitubercular agents. What is the cure rate?

isoniazid (INH); Rifampin, Pyraziniamide (PZA); Ethambutol; & Stretomycin. Combination therapy of these drugs produces a 95% cure rate.

What is the MOA of Isoniazid (INH)?

Alters the nicotinamide adenine denucleotide (NAD) of the mycobacterium organism and inhibits cell wall synthesis.

In what clients is INH therapy contraindicated?

allergy, hepatic injury or acute liver disease, & optic neuritis clients.

What are possible side effects of INH?

Can be hepatotoxic & cause peripheral neuritis (numbness & tingling)

What drugs are inhibited if INH therapy is implemented?

phenytoin, carbamazepine, primidone, & warfarin

What client education needs to be given regarding INH therapy?

Should be taken on an empty stomach & it can cause a false positive glucose test.

What is the MOA of Rifampin?

Inhibits protein synthesis of the cell.

What side effects can Rifampin cause?

hepatotoxicity, hepatitis, & hematologic disorders

What client education needs to be given regarding Rifampin therapy?

Teach the client that this drug will turn urine, tears, sweat & sputum and orange/reddish color. Soft contact lenses will be permanently discolored. Women taking oral contraceptives should switch to another form of birth control since this drug causes oral contraceptives to become ineffective.

Why will other medication drug doses have to be adjusted while receiving Rifampin therapy?

It may enhance elimination of theophylline, steroids, opiods, oral hypoglycemics, warfarin, Vitamin D, beta-blockers, & benzodiazepines.

What is the MOA of Pyrazinamide?

Drug action is not understood, but believed to serve as a bacteriostatic or bacteriocidal agent, therby destroying the mycobacterium in the macrophages.

Back 88

Severe asthma

Front 89

When is Pyrazinamide therapy implemented?

What side effects does the nurse need to be aware of with Pyraziniamide therapy?

hepatotoxicity and hyperuricemia

How is Ethambutol used for the TB drug regimen?

It is used as the 4th drug agent.

What is the MOA of Ethambutol?

Inhibition of mycolic acid synthesis in the cell

What side effects does the nurse need to be aware of with Ethambutol therapy?

neurotoxicities and blindness.

How are the side effects of Ethambutol monitored?

Eye exams should be performed at drug initiation. Clients should immediately report any visual changes to MD.

Which clients should Ethambutol be used with caution?

Clients w/diabetes, or liver, renal or hematologic disorders.

What drug can be used as a substitute for Ethambutol?

Streptomycin can be used as the 4th agent instead of Ethambutol.

What is the MOA of Streptomycin?

Inhibition of cellular protein synthesis.

What serious side effects can Streptomycin cause?

ototoxicity, nephrotoxicity, & blood dyscrasias

How are the side effects monitored?

Obtain a baseline audiometric test every 1 to 2 months since it can impair the 8th cranial nerve.

Which clients are more prone for drug complications with Streptomycin?

Older clients.

Back 89

Usually added to INH for the first two months of therapy because it will prevent some of the neurologic side effects caused by INH (numbness & tingling of extremities.)

Front 90

acetylcysteine (Mucomyst)

guaifenesin (Robitussin) Mucolytic Drugs: Expectorant

atropine
D. Drugs that Antagonize Bronchial Secretion
Anticholinergic agents

iapratropium
D. Drugs that Antagonize Bronchial Secretion
Anticholinergic agents

epinephrine (Adrenalin) BRONCHODILATOR Drugs
Sympathomimetic Drug
Nonselective Adrenergic Drugs

isoproterenol solution (Isuprel) BRONCHODILATOR Drugs
Sympathomimetic Drug
Nonselective Beta-Adrenergic Drugs

albuterol (Proventil, Ventolin) BRONCHODILATOR Drugs
Sympathomimetic Drug
Selective Beta2 Receptor Drugs

terbutaline (Brethine) BRONCHODILATOR Drugs
Sympathomimetic Drug
Beta 2 receptor drug

iprotropium (Atrovent)** BRONCHODILATOR Drugs
Anticholinergic Bronchodilator Agent

montelukast (Singular)
zafirlukast (Accolate)**
zileuton (Zyflo) BRONCHODILATOR Drugs
Leukotriene Antagonists

aminophylline
oxtriphylline
theophylline** BRONCHODILATOR Drugs
xanthine Derivatives: Phosphodiesterase Inhibitors

cromolyn (Intal)** PROPHYLACTIC ANTIASTHMATIC Drugs

Necromil (Tilade) PROPHYLACTIC ANTIASTHMATIC Drugs

beclomethasone (Beclovent)** CORTICOSTEROIDS
also antiinflammatory agents

flunisolide (AreoBid) CORTICOSTEROIDS
also antiinflammatory agents

codeine phosphate** COUGH SUPRESSANTS
Opioid Antitussive Drugs

cydrocodone bitartrate** COUGH SUPRESSANTS
Opioid Antitussive Drugs

guiafenesin and codeine (Robitussin A-C)**
COUGH SUPRESSANTS
Opioid Antitussive Drugs

benzonatate (Tessalon)** COUGH SUPRESSANTS
Nonopioid Antitussive Drug

diphenhydramine (Benadryl)** COUGH SUPRESSANTS
Nonopioid Antitussive Drug

dextromethorphan BR (Benylin DM, Robitussin DM)**
COUGH SUPRESSANTS
OTC Antitussive Drugs

acetylcysteine (Mucomyst) COUGH SUPRESSANTS
Mucolytic Drugs

guaifenesin (Robitussin)** COUGH SUPRESSANTS
Expectorant

ammodium chloride** COUGH SUPRESSANTS
Expectorant

iodinated glycerol (Iophen)** COUGH SUPRESSANTS
Expectorant

potassium iodine (SSKI)** COUGH SUPRESSANTS
Expectorant

diphenhydramine (Benadryl)** ANTIHISTAMINE
H1 Receptor Antagonists

loratadine (Claritin) ANTIHISTAMINE
H1 Receptor Antagonists

cetirizine (Zertec) ANTIHISTAMINE
H1 Receptor Antagonists

fexofenadine (Allegra) ANTIHISTAMINE
H1 Receptor Antagonists

astemizole (Hismanal) ANTIHISTAMINE
H1 Receptor Antagonists

cromolyn sodium ANTIHISTAMINE
Inhibitor of Histamine Release

pseudoephedrine (Sudafed) DECONGESTANTS
Oral (OTC)

phenylephrine
(Neo-Synephrine, Sinex)** DECONGESTANTS
Adrenergic Nasal decongestant

ephedrine (Pretz-D) DECONGESTANTS
Adrenergic Nasal decongestant

oxymethazoline (Afrin) DECONGESTANTS
Adrenergic Nasal decongestant

tetrahydrozoline (Tyzine Pediatric Drops)
DECONGESTANTS
Adrenergic Nasal decongestant

naphazoline (Privine) DECONGESTANTS
Adrenergic Nasal decongestant

desoxyephedrine (Vicks Inhaler) DECONGESTANTS
Inhalation (OTC)

propylhexedrine (Benzedrex Inhaler)
DECONGESTANTS
Inhalation (OTC)

beclomethasone (Beconase, Vancenase) DECONGESTANTS
Intranasal Steroids

fluticasone (Flonase) DECONGESTANTS
Intranasal Steroids

triamcinolone (Nasocort) DECONGESTANTS
Intranasal Steroids

cromolyn sodium DECONGESTANTS
Intranasal Steroids

beractant (Survanta) SURFACTANTS

calfactant (Infasuf) SURFACTANTS

colfosceril (Exosurf Neonatal) SURFACTANTS

Back 90

Mucolytic Drugs: Expectorant

Front 91

Codeine

dextromethorphan
cough suppression
SE: dizziness

ribavirin
antiviral used for RSV and HepC
SE: anemia, conjunctivitis, dizziness, blurred vision, photosensitivity

guaifenesin (Robitussin) expectorant

aminophylline and theophylline bronchodilators
SE: tachycardia, anxiety, N/V
*check serum levels!

albuterol (AccuNeb, Ventolin) bronchodilator
SE: nervousness, restlessness, tremor, CP, palpitations

salmeterol (Serevent)
bronchodilator
SE: headache

Zafirlukast
leukotriene receptor agonist
used to decrease frequency/severity of asthma

beclomethasone (Qvar)
steroid
used to treat asthma

cromolyn sodium (Nasalcrom) reduces frequency/intensity of allergic reactions

phenylephrine hydrochloride decreases nasal congestion
SE: rebound effect

Pseudoephedrine
reduces nasal congestion

Isoniazid
antitubercular - bacteriacidal
SE: drug-induced hepatitis, peripheral neuropathy

Ethambutol
antitubercular - growth inhibitor
SE: drug induced hepatitis, optic neuritis

rifampin
antitubercular - bacteriacidal
SE: drug induced hepatitis, red discoloration of body fluids, abd pain, diarrhea, N/V

Dornase alpha (Pulmozyme) DNA enzyme
used to treat cystic fibrosis

Acetylcysteine (MUCOMYST) mucolytic
lowers mucus viscosity
*also treatment for acetaminophen overdose

Back 91

cough suppression, pain control, diarrhea control
SE: sedation, constipation

Front 92

What are the two types of receptors for histamine?

What does H1 receptors mediate?
1. smooth muscle contraction
2. dilation of capillaries

What does H2 receptors mediate?
1. exceleration of heart rate
2. exceleration of gastric secretions

What are the overall effects of histamine?
1. contriction of smooth muscle
(especially in the stomach and lungs).
2. Increase in body secretions.
3. vasodilation
4. Increase in capilary permeability.
5. Drop in BP
6. Edema

Name the 4 H2 antagonists or H2 blockers.
1. cimetidine
2. ranitidine
3. famotidine
4. nizatidine

What is the H1 antihistamines (H1 blockers) use for?
the treatment of allergies

Mechanism of Antihistamine
1. Acts by blocking the H1 receptors on the surface of basophils and mast cells.
2. Competes with histamine for the unoccuplied receptors.
**does not push off histamine that is already bound to a cell surface receptors.**

Indications of Antihistamine
1. Skin: wheal, flare formation, and iching.
2. Sesonal or perennial allergic rhinitis
3. Some symptom of common cold

What class of drugs is the action antihistamine similar to? Anticholinergic

Side effects of Histamine
1. drowsiness
2. dry mouth
3. change in vision
4. difficulty urinating
5. constipation

Drugs that may interact with Fexofenadine. erythromycin or ketoconazole
-may increase the level of Fexofenadine-

Drugs that may interact with antihistamine in general.
1. ketoconazole
2. cimetidine
3. erythromycin
4. loratadine
(may increase the concentration of loratadine there by increase the depressant effects)

Class of cetirizine (Zertec)
H1 antihistamine

class of desloratadine (Clarinex) H1 antihistamine

class of fexofenadine (Allegra) H1 antihistamine

class of loratadine (Claritin) H1 antihistamine

class of and indications for
diphehydramine (Benadryl)
H1 antihistamine
1. allergic disorders
2. night time sleep aid
3. motion sickness

fexofenadine/psuedoephedrine (Allegra-D) is not recommended for person with...
1. hypertension
2. diabetes
3. ischemic heart disease
4. glaucoma
5. hyperthyroidism
6. renal impairedment
7. prostate disease

adverse effects of fexofeadine/psuedoepedrine may stimulate the nervous system causing cardiac collapse.

class of fexofeadine/psuedoepedrine H1 antihistamine

Class of cetirizine (Zyrtec)
and indication.
Anticholinergic: H1 antihistamine
treatment of year round allergies as well as seasonal allergies.

Antihistamine should be used with caution in clients with..
1. brochial asthma
2. increase intraoccular pressure
3. prostatic hypertrophy
4. elderly

What are the three group of nasal decongestants?
1. adrenergic (sympathomimetic)
2. anticholinergic (parasympatolytic)
3. topical corticosteroids (intranasal steroids)

Name the commonly used oral decongestant available OTC. 1. pseudoephedrine (Sudafed)
2. guaifenesin (Robintussin)

Name the commonly used nasal decongestant spray available OTC. phenylephrine (Neo-Synephrine)

List the pros and cons of oral decongestant.
Pros:
1. pro-longed decongestant effect.
2. no rebound congestion
Cons:
1. delayed onset activities.
2. less potent than topical decongestant.
3. may affects vascular beds other than those in the nasal mucosa.
4. may also precipitate or agrravate high BP, cardiac arrhythmias, ischemic heart disease, DM, and hyperthyroidism.

List the pros and cons of topical decongestants.
Pros:
1. produces potent decongestion effect.
2. prompt onset of action.
Cons:
1. rebound congestion
2. adverse systemic effects such as elevation of BP and CNS stimulation may occurs if the decongestant drains through the nasal passage and swollowed by the client.

Name 5 adrenergic nasal inhalation decongestants.
1. *naphazoline (Privine)* alpha-adrenergic vasoconstrictor
2. tetrahydrozoline (Tyzine Pediatric Drops)
3. oxymetazoline (Afrin)
4. phenylephrine (Neo-Synephrine, Sinex)
5. ephedrine (Pretz-D)

ephedrine (Pretz-D)
nasal inhalation decongestant

naphazoline (Privine)
nasal inhalation decongestant

oxymetazoline (Afrin)
nasal inhalation decongestant

phenylephrine (Neo-Synephrine, Sinex)
nasal inhalation decongestant

Name two adrenergic inhalation decongestion used orally.
1. desoxyephedrine (Vicks inhaler)
2. propylhexedrine (Benzedrex inhaler)

What is the indications for inhaled intranasal steroids and anticholinergic agents?
used prophylactically to prevent nasal congestion in patient with chronic upper respiratory symptoms.
**do not cause rebound congestion**

Name commonly used intranasal steroids.
1. Beconase**
2. Flonase**
3. Vancenase
4. Pullmicort
5. Rhinocort
6. Nasacort
7. nasalide
8. Turbuhaler

What is the mechanism of adrenergic nasal decongestant agents?
-shrink engorged nasal mucosal membranes and relieve nasal stuffiness by stimulating the Alpha1-adrenergic nerve receptors in vascular smooth muscles.
-Thereby constricting the small arterioles that supply the structures of the upper respiratory tract, primarily the blood vessle surrounding the nasal sinuses.
-reduces flow and allows for drainage.

What is the mechanism of nasal steroids decongestant agents? nasal steroid are aimed at the inflammatory response elicited by the invading organisms (viruses and bacteria) or antigens. Steroids exert their antiinflammatory effect by causing these cells to be turned off rendered unresponsive.

Indications for nasal decongestants.
1. acute or chronic bronchitis
2. common cold
3. sinusitis
4. hay fever
5. allergies
6. reduces swelling of the nasal passages
7. facilitate visualization of the nasal and pharyngeal membranes before sugery or diagnostic procedures.

Contraindications for
adrenergic nasal decongestant.
1. drug allergy
(Adrenergic drugs)
2. narrow-angle-glaucoma
3. uncontrolled cardiovascular disease
4. diabetes
5. thyroid dysfunction
6. prostatitis

Side effects/ Adverse reaction for nasal decongestants. Adrenergic:
1. nervousness
2. insomnia
3. palpitation
4. tremor
intranasal steroids:
1. mucosal irritaion
2. mucosal dryness

Systematic effects of nasal decongestants.
1. headache
2. nervousness
3. dizziness

Interactions for nasal decongestants.
1. sympathomimetic drugs and sympathomimetic nasal decongestants are more likely to cause toxicity when given together.
2. MAOIs may result in additive pressor effects (i.e. raising BP) when given with sympathomimetic nasal decongestion.

What should the nurse monitor for when client is using
intranasal steroid products?
1. developement of nasal irritation and dryness
2. systemic steroid effects such as:
- fluid retension
- CFH
- weight gain
- menstrual irregularities
- muscle weakness
- increase suceptibility to fracture and infection.
- decrease effetiveness of immunization due to steroidal effects.

What is Cromolyn Sodium drug use in the tratment of allergic rhinitis.

Class & Mechanism of cromolyn sodium
-Antiallergic Agent & Antiasthmatic drug (prophylactic)
-inhibits histamine release and other chemical agents liberated as a result of allergic response by stabilizing mast cells.

What is that advange of saline nose drop?
1. non habit forming
2. can be use more often during the day than most decongestants
3. inexpensive

Name 5 commonly use expectorants.
1. ammonium chloride
2. guaifenesin* (Robitussin, Guiatuss, Humibid)
3. potassium iodine* (SSKI)
4. iodinated glycerol* (Iophen, Organidine)
5. terpin hydrate

Class and Mechanism of
Guaifenesin
(Robitussin, Guiatuss, Humibid) -Expectorant
-Reflex stimulation:
loosening and thinning of the respiratory tract;
-secretions occurs in response to an irritation of the GI tract produced by the drug.

Side effects of
Guaifenesin
(Robitussin, Guiatuss, Humibid) 1. stomach upset
2. nausea

What expectorant is not approved by the FDA?
Ammonium Chloride

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H1 and H2

Front 93

Class and Mechanism of iodinated glycerol and potassium iodine

Class and Mechanism of Ipecac syrup.
Expectorant;
stimulate the flow of gastric and respiratory tract secretions.

Usage of Ipecac syrup
1. low dosage (0.25-1) expectorant
2. high dosage (15ml) potent emetic

Class and Mechanism of
Terpin hydrate
-expectorant
-act by stimulating the secretory glands directly to increase natural respiratory tract secretions.

Name two main indications of
expectorants
1. relief of productive cough.
2. Supression of coughs caused by chronic paranasal sinusitis.
What are the contraindications for expectorants? 1. drug allergy
2. hyperkalemia
(for potassium contanning expectorant)
what are the side effects of expectorant? 1. nausea
2. vomiting
3. GI upset
Iodine= above + rash hypersensitivity
List 2 drugs interations that may occur with the use of expectorant. 1. Iodinated product + lithium or antithyroid drugs = hypothyroidism
2. Iodinated product + potassium-sparing diuretics = hyperkalemia
Name the 3 narcotic antitussive agents. 1. codine phosphate
2. hydrocodone bitartrate
2. guaifenesin and codine (Robitussin A-C)
Describe the MOA of narcotic antitussive agents. supress the cough reflex through a direct action on the cough center in the CNS.
List the side effects of narcotic antitussive:
Codine & Hydrocodone 1. sedation
2. nausea
3. vomiting
4. lightheadedness
5. constipation
List interaction that may occurs with narcotic antitussive:
Codine & Hydrocodone potentiate the effects of:
1. other opiods
2. general anesthetics
3. tranquilizers
4. sedative or hypnotics
5. tricyclic antidepressants (TCAs)
6. MAOIs
7. alcohol
8. other CNS depressants
narcotic antitussive must be use in great caution with: 1. preexisting pulmonary distress
2. those using psychotropic agents
3. sedative-hypnotics
4. alcohol
5. other CNS depression
List the three non-narcotic antitussive agents. 1. benzonatate (Tessalon)
2. dextromethorphan HBr* (benylin DM, Robitussin DM)
3. diphenhydramine HCl (Benedryl)
Mechanism of
dextromethorphan HBr
(Benylin DM, Robitussin DM) acts on the cough center inthe medulla, but does not cause respiratory depression, analgesia, or dependence.
Mechanism of
benzonatate (Tessalon) acts by providing local anesthetic action, which impairs sensation of the stretch receptors located in the respiratory tract, thereby interfering with the cough reflex.
Side effects of
dextromethorphan HBr
(Benylin DM, Robitussin DM) 1. dizziness
2. drowsiness
3. nausea
side effects of
benzonatate (Tessalon) 1. dizziness
2. headache
3. sedation
4. nausea
5. constipation
6. pruritus
7. nasal congestion
side effects of
diphenhydramine (Benedryl) 1. sedation
2. dry mouth
3. and other anticholigic effects
Interaction for nonnarcotic antitussin:
dextromethorphan HBr
(Benylin DM, Robitussin DM) dextromethorphan may potentiate the serotonergic effects of MAOIs and thus concurrent administration is contraindicated.
Decribe the mechanism of brochodilation caused by sympathomimetic agents. when the Beta 2 receptors of mast cells is stimulated by sympathomimetic agents, there is an increase in the formation of cyclic AMP. cAMP is associated with smooth muscle relaxation and bronchodilation.
Sympathomimetic agent => B2 => cAMP => bronchodilation.
Give 2 examples of commonly used sympathomimetic bronchodilators: 1. albuterol (Proventil, Ventolin)
2. terbutaline sulfate (Brethaire, Brethene, Bricanyl)
What should clients taking sympathomimetic bronchodilators be monitored for? 1. changes in cardiac function
2. changes in BP
3. CNS stimulations such as insomnia, nervousness, anxiety, tremor, and GI disturbances.
List contraindications for sympathomimetic bronchodilators. Client on sympathomimetic bronchodilators should not use:
1. MAO inhibitors
2. tricyclic antidepressants
3. antihisamine
4. sodium levothyroxine
Describe the mecahinism of Xanthine Bronchodilators. The agent interfere with the action of phosphodiesterase, an enzyme that breaks down cyclic AMP to inactive product. An increase in intracellular cAMP leads to brochodilation.
Xanthine x=> PhDR x=> cAMP => bronchodilation
Give 3 classes of Xanthan. 1. caffeine
2. theophylline
3. theobromine
List side effects of Xanthine. 1. tachycardia
2. dysrhythmias
3. diuresis
Name 4 example of Xanthine bronchodilator drugs. *generic name ends with "phylline"*
1. aminophylline
2. dyphylline
3. oxtriphylline
4. theophylline
what is the rate of administration for aminophylline? not exceed 25mg/min using a contiuous IV infusion pump.
What should the client who are taking Xanthine bronchodilator drugs be monitored for? stimulation of CNS:
1. insomnia
2. hyperexcitability
3. potential for seizure activity
What is the therapeutic range for theophylline and when should it be taken? 10-20 mcg/mL
1-2 hours after immediate acting
about 4 hours after sustained-release
List the side effects of Xanthine bronchodilator drugs. Common:
1. nausea
2. vomiting
3. anorexia
Others: gasstrointestinal reflux, sinus tachycardia, ventricular dysrhythmias, increase urination, hyperglycemia.
How do you treat an overdose of Xanthine bronchodilator drugs. with syrup of ipecac
List drugs that will interact with Xanthine bronchodilator drugs 1. allopurinol
2. cimetidine
3. erythromycin
4. flu vaccine
5. contraceptives
list the indications for Xanthine bronchodilator drugs 1. acute asthma
2. chronic bronchitis
3. emphysema
4. COPD
List contraindication to Xanthine bronchodilator drugs 1. drug allergy
2. cardiac dysrhythmias
3. seizure
4. hyperthyroidism
5. peptic ulcers
Name three leukotriene receptor antagonists. 1. zafirlukast (Acculate)
2. montelukast (Singular*)
3. zileuton
Classificaion of
montelukast (singular) leukotriene receptor antagonists: antileukotriene
Mechanism of leukotriene receptor antagonists Act by bloking leukotriene-mediated bronchoconstriction.
Indications of leukotriene receptor antagonists 1. chronic stable asthma
2. exercise-induced asthma attacks
3. allergies
**not for acute asthma attack**
Side effects of leukotriene receptor antagonists. 1. headache
2. drowsiness
3. fatique
4. GI diturbances
5. liver dysfunction
What are some cautions for client taking leukotriene receptor antagonists? clients taking zafirlukast (Acculate) who are also taking Warfarin should be monitored to adjust the anticoagulant as needed.
What is the only anticholinergic drug use as a brochodilators? ipratropium bromide (Atrovent)
Mechanism of
ipratropium bromide (Atrovent) antagonize the action of acetylcholine, thereby resulting in bronchodilation.
Contraindications of
ipratropium bromide (Atrovent) clients with glaucoma
Side effects of zafirlukast (Acculate) 1. headache
2. nausea
3. diarrhea
What are the adverse effects of
ipratropium bromine(Atrovent) 1. dry mouth or throat
2. GI distress
3. headache
4. coughing
5. anxiety
What is the contraindications of
ipratropium bromide (Atrovent) hypersensitivity to atropine or any of its derivatives
What is a mucolytic agent? agent that reduces the thickness and the stickiness of pulmonary secretions so that removal by ciliary action and cough is facilitated and pulmonary ventilation can be improved.
Name the most commonly used mucolytic agent. acetylcysteine (Mucomyst)

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Expectorant;
act by direct stimulation of the secretory glands in the respiratory tract.

Front 94

Class and mechainism of
acetylcysteine (Mucomyst)


What are the methods of administration of
acetylcysteine (Mucomyst)
1. nebulization: tent, facemask, or mouthpiece
2. direct instillation of the solution into an intratracheal catheter.
What are some of the dos donts concerning with the administration of
acetylcysteine (Mucomyst) 1. should not be mixed with many drugs
2. should not touch iron, copper, and ruber.
3. should be made to use only glass, plastic, aluminum, or stainless steel part.
What are the adverse effects associated with
acetylcysteine (Mucomyst) development of bronchospasm as a result of the aerosol administration.
Usage of:
cromolyn sodium and nedicromil sodium 1. prophylactic treatment of bronchial asthma in client who require long-term therapy to control their disease.
2. those whose asthma attacks follow a predictable pattern.
Mechanism of:
cromolyn sodium and nedicromil sodium inhibits the release of histamine and other substances from sensitized mast cells.
How is cromolyn sodium and nedicromil sodium administer? poorly absorbed from the gastrointestinal, so they are generally adminitered by inhalation as a solution to be inhale by a nebulizer.
Contraindication for:
cromolyn sodium and nedicromil sodium 1. acute asthma attack
2. status asthmaticus
side effects of:
cromolyn sodium and nedicromil sodium 1. cough
2. bronchospasm
What are some nursing implication for:
cromolyn sodium and nedicromil sodium? 1. properly instruct client on the method of administration
2. impressed the client with the need for adhering to the prescribed regiment.
When is cromolyn administer by orally? in the treatment of mastocytosis becuse cromolyn dose exert a local action in the mast cells w/i the GI tract.
When is corticosteroid use in the respiratory system? prophylactic treatment of bronchial asthma.
mechanism of corticosteroid produce an antiinflammatory effects by decrease the number of inflammatory cells in the respiratory tract, which leads to decrease bronchoconstriction.
What are some common corticosteroid inhaler drugs use in the treatment of asthma? *most generic name ends with "sone"*
1. beclomethasone* (Beclovent, Vanceril)
2. flunicasone (Flonase*, Flovent)
Side effets/Adverse reaction of corticosteroids inhalers. 1. GI distress
2. cough
3. dizziness
4. headache
5. bad taste in your mouth
6. oral fugal infection (candidiasis)
What the two example of mast cell stablizers? 1. cromolyn
2. nedocromil
What is the mechanism of cromolyn and nedocromil? indirect-acting agents because they prevent the release of various intracelluar chemical mediators that cause brochospasm, as oppose to blocking the receptors for these substances.
What is the use for
cromolyn and nedocromil? used as adjuncts to the overall management of Pt. with asthma and are used solely for prophylaxis, not for acute asthma attacks.
What are the side/adverse effects of
cromolyn and nedocromil? 1. coughing
2. sore throat
3. rhinitis
4. bronchospasm
other includes: taste chages, dizziness, and headache.
What is the class, action, and uses of cyproheptadine? -antihistamine
-exerts a local anesthetic action
-treatment of pruritus
Class and uses of:
cyclizine, trimeprazine, methdilazine, meclizine, and promethazine. *generic name ends with "zine"*
-antihistamine
-preventing or countering
motion sickness as well as
nasea and vomiting.
Name the three antihistamine that are currently available in US, and are similar in chemicle structure to phenothiazine antipsychotic agents. 1. trimeprazine
2. methdilazine
3. promethazine
These three agents are contraindicated in what types of clients? trimeprazine, methdilazine, promethazine 1. comatose
2. sensitive to phenothiazine drugs
3. hepatic disorders
4. CNS depression (due to barbiturates, narcotic analgesics, or alcohol)
Class, mechanism, effects of:
astemizole (Hismanal)
cetirizine HCl (Zyrtec)
loratadine (Claritin)
fexofenadine (Allegra) -H1 antihistamine
-specific in blocking peripheral H1 histamine receptors.
-result in lower incident of sedation.

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mucolytic agent
it breaks down chemical bond resposible for the high viscosity of mucus.

Front 95

codeine

dextromethorphan antitussives

ribavirin
antiviral

guaifenesin (Mucinex) expectorant

aminophylline (Phyllocontin) bronchodilators, xanthines

theophylline (Uniphyl) bronchodilators, xanthines

albuterol (Ventolin) bronchodilators, adrenergics

salmeterol (Serevent) bronchodilators, adrenergics
influenza vaccine vaccinations
Zafirlukast leukotriene receptor antagonist
beclomethasone (Beconase AQ) inhaled corticosteroids, anti-inflammatories
prednisone (Sterapred) corticosteroids, antiasthmatics
methylprednisolone (Solu-Medrol) corticosteroids, antiasthmatics
cromolyn sodium airway desensitization for allergic reactions
phenylephrine hydrochloride topical decongestants, adrenergics
pseudoephedrine (Sudafed) systemic decongestants, allergy cold & cough remedies
isoniazid anti-tuberculins
ethambutol anti-tuberculins
rifampin (Rifadin) antituberculars, rifamycins
dornase alfa (Pulmozyme) DNA pulmonary enzymes, cystic fibrosis therapy adjuncts
acetylcysteine (Mucomyst) mucolytics, antidote for acetaminophen toxicity

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antitussives; opioid agonists

Front 96

Metaproterenol (Alupent)

Albuterol
Beta adrenergic agonist>Rapid acting short duration.

Onset: < 15 minutes
Duration: 2-4 hours

Levalbuterol
Beta adrenergic agonist>Rapid acting, short duration

Pirbuterol
Beta adrenergic agonist>Rapid acting, short duration

Terbutaline
Beta adrenergic agonist>Rapid acting, short duration

Bitolterol
Beta adrenergic agonist>Rapid acting, short duration

Salmeterol
Beta adrenergic agonist>Long acting.
Controls nighttime asthma attacks.
Onset: slower
Duration: >12hours

Formoterol
Beta adrenergic agonist, Long duration

Ipratropium Bromide
Quartenary Muscarinic Receptor Agonist

Tiotropium Bromide
Quatenary Muscarinic Receptor Agonist

Theophylline
Methylxanthine Bronchodilators

Beclomethasone dipropionate (Biclovent)
Inhaled Corticosteroid

Budesonide dipropionate (Pulmicort)
Inhaled Corticosteroid

Flunisolide (AeroBid) Inhaled Corticosteroid

Triamcinolone acetonide (Azmacort)
Inhaled Corticosteroid

Mometasone
Inhaled Corticosteroid

Fluticasone
Inhaled Corticosteroid

Prednisone Systemic Corticosteroid

Methylprednisolone Systemic Corticosteroid

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Beta adrenergic agonist>Rapid acting, short duration

Front 97

Smells like rotten eggs, it is also used as an antidote for acetaminophen overdose to prevent liver failure.

Break the mucoprotein bonds in mucus to help liquify secretions. increase production of resp. tract fluids & reduce
viscosity of tenacious pts.

Mucolytics

acetlyscyteine (Mukomyst)
Dornase alfa (rhDNAase)
Guaifenesin (Robotussin)

mucolytics

Suppress cough reflex by a direct action on the cough center and are the most effective cough suppressants, also are narcotic

Opiod antitussives (ex:hydrocodone, codeine)

which antitussive is non-narcotic? dextromethrompone

Aid in the removal of excess mucous that has accumulated in the resp tract by loosening & thinning secretions. Expectorants

Ex of expectorants
guiafenesin (Robitussin)
iodinated glycerol (Organidin)
Potassium iodide ( Pima syrup)
terpin hydrate elixir

Side effects of guifensin n/v and gastric irritation
Pt teaching, expectorants Increase fluid intake to thin secrections
What do mast cell stabilizers do? Prevent degranulation of mast cells after exposure to antigens; excellent prevention of allergic asthma; DO NOT relieve acute asthma attacks, may make them worse!
How long does it take for mast cell stabilizers to have therapeutic effects? up to 3 weeks
Cromolyn sodium (Intal)
Nedocomil (Tilade) Mast cell stabilizers (antiasthmatic agents)
Who are mucolytic agents given to? Pts that have difficulty coughing up secretions such as COPD, CF, pneumonia, atelactasis, or tuberculosis
why should mucolytics (Mucomyst, Robotussin, rhDANase) be given with a bronchodilator? Because they may cause bronchospasm.
How are mucolytics administered? by nebulizer, direct instillation into the the trachea via ER tube or tracheotomy.
common s.e. of mucolytics G.I. upset, stomatitis, rhinorrhea, bronchospasm, rash
How long does it take for mast cell stabilizers to have therapeutic effects? up to 3 weeks
Cromolyn sodium (Intal)
Nedocomil (Tilade) Mast cell stabilizers (antiasthmatic agents)
Who are mucolytic agents given to? Pts that have difficulty coughing up secretions such as COPD, CF, pneumonia, atelactasis, or tuberculosis
why should mucolytics (Mucomyst, Robotussin, rhDANase) be given with a bronchodilator? Because they may cause bronchospasm.
How are mucolytics administered? by nebulizer, direct instillation into the the trachea via ER tube or tracheotomy.
How long does it take for mast cell stabilizers to have therapeutic effects? up to 3 weeks
Cromolyn sodium (Intal)
Nedocomil (Tilade) Mast cell stabilizers (antiasthmatic agents)
Who are mucolytic agents given to? Pts that have difficulty coughing up secretions such as COPD, CF, pneumonia, atelactasis, or tuberculosis
why should mucolytics (Mucomyst, Robotussin, rhDANase) be given with a bronchodilator? Because they may cause bronchospasm.
How are mucolytics administered? by nebulizer, direct instillation into the the trachea via ER tube or tracheotomy.
side effects mast cell stabilizers coughing, sore throat, rhinitis, bronchospasm, taste changes, dizziness, headache
theophylline(Theo-dur, Respbid,Slo-bid)
aminophylline (Somophylin,Cardophylin
dyphilline (Dilor)
oxtiphylline (Choledyl) methylxanthines
Relax sooth muscle of bronchial airway & pulmonary bv, resulting in bronchodilation. Indicated for symptomatic asthma relief. Chemically related to caffeine. Methylxanthines
Used to control brochospasm & increase diaphragm strength in pts with COPD. Stimulates CNS, respiration. dilates coronary & pulmonary vessels, cause diuresis, relax smooth muscles methylxanthines
Route of delivery for theophylline PO or IV
(inhalation ineffective)
side effects mast cell stabilizers coughing, sore throat, rhinitis, bronchospasm, taste changes, dizziness, headache
theophylline(Theo-dur, Respbid,Slo-bid)
aminophylline (Somophylin,Cardophylin
dyphilline (Dilor)
oxtiphylline (Choledyl) methylxanthines
Relax sooth muscle of bronchial airway & pulmonary bv, resulting in bronchodilation. Indicated for symptomatic asthma relief. Chemically related to caffeine. Methylxanthines
Used to control brochospasm & increase diaphragm strength in pts with COPD. Stimulates CNS, respiration. dilates coronary & pulmonary vessels, cause diuresis, relax smooth muscles methylxanthines
Route of delivery for theophylline PO or IV, rectal
(inhalation ineffective)
therapeutic range theophylline 8-20 u/mL
15-20 may cause N, V & A
>30 may cause cardiac dysrythmias
>40 may cause seizures, death
check blood levels often
side effects theophylline can cause palpitations, nervousness, restlessness, insomnia, N & V, and diarrhea.
contraindications to methylxnathines drug allergy, uncontrolled cardiac arrhythmias, seizure disorders, hyperthyroid, and peptic ulcers
client teaching methylxnathines limit caffeine, take as prescribed, limit smoking, drink plenty of fluids, don't take OTC cold remedies w/o checking with health care provider. monitor labs
Primatine Mist
Sus-prine
Epi-pen auto injector
Isoproternol Catecholamine Beta agonists (sympathomimetics)
Most commonly used Beta-2 agonist in treatment of acute asthma attacks, usually used as a rescue inhaler for bronchospasm. Albuterol (proventil)
side effects of Albuterol tachycardia, angina, tremor, but when used correctly usually minimal.
Only 2 long-acting Beta-2 Agonists for long term maintenance tx of asthma.
Bind selectively to beta 2 adrenergic receptors to cuase brochodialtion. take 30-60 min prior to exercise. Serevent Diskus (salmeterol)
Foradil Aerolizer (foradil)
Most commonly used Beta-2 agonist in treatment of acute asthma attacks, usually used as a rescue inhaler for bronchospasm. Albuterol (proventil)
side effects of Albuterol tachycardia, angina, tremor, but when used correctly usually minimal.
Only 2 long-acting Beta-2 Agonists for long term maintenance tx of asthma.
Bind selectively to beta 2 adrenergic receptors to cuase brochodialtion. take 30-60 min prior to exercise. Serevent Diskus (salmeterol)
Foradil Aerolizer (foradil)
S.E. of long-acting Beta-2 agonists serious side effects are uncommon. may have h/a, throat irritation, nervousness & restlessness. Can cause tachycardia so pts w/heart dz should be carefully monitored.
epiniphrine -
nonselective or selective beta agonist? non-selective adrenergic.
When given by inhalation, which are the most effective drugs available for relieving acute bronchospasm & preventing exercise induced bronchospasm. beta-2 agonists

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Mucomyst, acetylcysteine

Front 98

How often are long-acting beta-2 adrenergics used, what is their onset and what are the side effects?

Back 98

q 12 hr
onset delayed, but effects last up to 12 hours
minimal side effect

Front 99

Act by competing for leukotriene receptor sites, blocking inflammatory actions.
decrease edema, mucous formation, tissue constriction, inflammation.

Back 99

Anticholinergic agents
(leukotiene receptor antagonists)

Front 100

Antihistamines Uses?

Antitussives Uses?
suppress cough

Antitussives (opioids)?
codeine added
WATCH for resp depression!!

Antitussives (non-opioids)? used to supress cough that's non-productive, painful, or prevents sleep

Bronchodilators?
are used to relax the smooth muscle in the bronchi & bronchioles in conditions like asthma, bronchitis & emphysema

Adrenergic bronchodilators: beta 2?
adrenergic receptors in smooth muscles of bronchi & bronchioles-stimulate increased production of cAMP, which induces relaxation of smooth muscle & lets airways dilate.

Adrenergic bronchodilators: beta 1?
adrenergic receptors as well, which results in cardiac stimulation

Adrenergic bronchodilators: Selective beta 2?
adrenergic agonists produce bronchodilation w/ minimal sx of cardiac stimulation. (reason they're “selective”).

Anticholinergic bronchodilators? Ipratropium (Atrovent)don't relieve acute bronchoconstriction, but enhance bronchodilating effects adrenergics. SE: GI distress, cough, hypotension.

Xanthines?
increase cAMP, by inhibiting enzyme that breaks it down. cause mild diuresis by increasing blood flow to kidneys. theophylline (Theo-Dur)

Theophylline (Theo-Dur)?
monitor serum drug levels regularly (drugs narrow safety and toxicity margin; can cause fatal arrhythmias. Therapeutic levels are 10 – 20 mcg / ml

Expectorants?
stimulate resp secretions and thin mucus for easier expectoration

Inhaled Corticosteroids?
reduce airway inflammation, increase # & sensitivity of beta- 2 receptors to adrenergic bronchodilators

Leukotriene Modifiers?
prevent asthma sx by suppressing synthesis of leukotrienes or blocking their receptors

Mast Cell Stabilizers?
reduce sx of inflammation in the resp tract by preventing release of histamine from mast cells-Cromolyn (Intal)

Asthma Prevention Meds? Cromolyn (Intal), Montelukast (Singular), & Zafirkulast (Accolate)

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allergic reactions, induce sleep, relieve nausea, prevent motion sickness

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Mucolytics?

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react directly w/ mucus-makes thinner (easier to expectorate).

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Short-acting B2 agonist

Concerning short-acting B2 agonist:
- when is the onset of action?
- how long is the duration?

How are Short-acting B2 agonists administered?
metered dose inhalers (MDIs) or nebulizer

The examples below are from which bronchodilator class?
- albuterol (Proventil)
- levalbuterol (Xopenex)
Short-acting B2 agonist

What route can albuterol be given besides inhalation?
PO

Which bronchodilator:

- used to prevent episodes of bronchoconstriction
- slower onset of action
- duration up to 12 hours Long-acting B2 agonist
What rule applies to the frequency of taking long-acting B2 agonist Never take more frequently than q12hr
The examples below are from which bronchodilator class?

- formoterol (Foradil)
- salmeterol (Serevent) Long-acting B2 agonist
What long-acting B2 agonist is sometimes given to prevent preterm labor? terubutaline (Brethine)
What bronchodilator:

blocks the action of aCH in bronchial smooth muscle when administered via inhalation Anticholinergics
When are anticholinergics indicated? - long-term management of COPD
- bronchoconstriction
When are Anticholinergics contraindicated? - cautious use with narrow-angle glaucoma (increase intraocular pressure)

- BPH (causes urinary retention & anticholinergic prevents contraction of bladder :(
What are the side effects of Anticholinergics (try to name 5) - dry mouth
- urinary retention
- cough
- nervousness
- nausea
- GI upset
- headache
- dizziness
The examples below are from which bronchodilator class?

- ipratropium (Atrovent)
- tiotropium (Spiriva) Anticholinergics
Which bronchodilator?

- unknown method of action
- 2nd line drug in asthma & COPD Xanthines
When are Xanthines contraindicated? emergency tx of bronchospasm
When do side effects to Xanthines usually present? with elevated serum levels
What are some side effects to Xanthines? (try to name 5) - anorexia
- N/V
- agitation
- nervousness
- insomnia
- dysrhythmias
- tonic-clonic seizures
The example below are from
which bronchodilator class?

- theophylline (Aminophyilline, Theo-dur) Xanthines
Which routes can Xanthine be administered? IV and PO (sustained release far more common)
What is the therapeutic range for Xanthines? serume theophylline 5-15 mcg/mL (narrow range)
When should blood be drawn after Xanthine administration? - 1-2 hours after immediate release

- 4 hours after SR
How is the dosage for Xanthines calculated? using lean body mass
What is the nursing implication concerning administration if GI upset occurs with Xanthine administration? take with a glass of H2O or food
What respiratory drugs suppress the inflammatory process and decrease mucus secretion, mucosal edema, repair of damaged epithelium, reduced airway reactivity. Also increased B2 receptors, enhancing responsiveness to B2 agonist Corticosteroids
When are corticosteroids indicated? - Acute asthma (IV or PO in high/multiple doses)
- Chronic asthma (daily inhalation)
What are some contraindications for corticosteroid use? - caution with PUD
- inflammatory bowel disease
- HTN
- CHF
- thromboembolic disorders
What are some side effects to corticosteroid use? - fewer with short-term use
- chronic use in children may retard growth & bone mass, and decrease adrenal function
- avoid high doses in children
- oropharyngeal candidiasis, hoarseness (rinse mouth)
- adrenal insufficiency may occur with systemic use or high doses of inhalation
- high dose in elderly increases risk of osteoporosis
- SYSTEMIC ROUTE LIKELY TO CAUSE HYPERGLYCEMIA
the following are example of which respiratory drugs:

- PO - prednisone (Deltasone)
- IV - hydrocortisone (Solucortef), methylprednisolone (Solu-medrol)
- Inhalation - fluticasone (Flonase), triamcinolone (Azmacort), beclomethasone (Beconase) Corticosteroids
Advair is a mixture of corticosteroids and what B2 agonist? Serevent (given q12 hours)
When are Leukotriene modifiers indicated? - long-term management of asthma in adults and children
Which Leukotriene modifier is contraindicated in liver disease? zileuton (Zyflo)

(increase LFT with Zyflo)
What are some side-effects of Leukotriene modifiers? - HA
- nausea
- diarrhea
- infection
the following are examples of which respiratory drugs:

- montelukast (Singulair)
- zileuton (Zyflo) Leukotriene Modifiers
Which respiratory drugs prophylactically stop the release of inflammatory mediators when mast cells come in contact with allergens and/or other stimuli Mast Cell Stabilizers
When are Mast Cell Stabilizers indicated? prophylaxis for acute asthma attacks
When are Mast Cell Stabilizers contraindicated? - acute bronchospasm
- status asthmaticus
- caution in renal/hepatic impairment
What are some side effects of Mast Cell Stabilizers? - dysrhythmias
- hypotension
- chest pain
- dizziness
- convulsions
- anorexia
- N/V
- CNS depression
the following are examples of which respiratory drugs:

- cromolyn (Intal)
- nedocromil (Tilade) Mast Cell Stabilizers
What route are Mast Cell Stabilizers given? inhalation
Which respiratory drugs block receptors on mast cells and basophils by binding to IgE, ultimately preventing the release of inflammatory mediators Immunosuppressant Monoclonal Antibodies
When are Immunosuppressant Monoclonal Antibodies indicated? allergic asthma unrelieved with corticosteroids
What are some side effects of Immunosuppressant Monoclonal Antibodies? - URI
- pharyngitis
- sinusitis
the following is from which respiratory drugs

- omalizumab (Xolair) [SC route] Immunosuppressant Monoclonal Antibodies
How long should one wait between MDI puffs? 3-5 minutes

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- 5 min
- 3-8 hours

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What are Beta2 agonists contraindicated for?

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Allergy & uncontrolled cardiac dysrhythmias.

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What are side effects of Beta2 Agonists?

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HTN or hypotension, vascular headaches, & tremor

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Name the types of Beta2 Agonists.

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Short-acting & Long-acting

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What do Short-acting Beta2 Agonists do?

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Provide rapid but short-term relief.

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When are Short-acting Beta2 Agonists most useful?

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When inhaled at beginning of asthmatic attack or as a premedication prior to activities that trigger or induce an asthmatic attack.

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Name some common short-acting Beta2 agonistic agents.

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Albuterol (Proventil, Ventolin); Bitalterol (Tornalate), & Pirbuterol (Maxair)

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How are the long & short-acting Beta2 agonistic agents delivered?

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Directly to the site of action by a Metered Dose Inhaler (MDI) or Dry Powder Inhaler.

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How can you tell a DPI is empty?

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(without a mouthpiece) it will float in water.

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When might you observe systemic effects from the use of a short-acting Beta2 agonistic agent?

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When it is overused or abused.

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If the client is using other drugs, when do you administer the Beta2 agonist bronchodilator?

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Five minutes prior to other inhaled drugs (i.e. steroids).

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How is a long-acting Beta2 Agonist different from a short-acting one?

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It takes more time to build up effects, but lasts longer. Useful to prevent attack, but of no value during an asthmatic attack since they take time for effects to accumulate.

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Name some common long-acting Beta2 agonistic agents.

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Salmeterol (Serevent); Formoterol Fumarate (Foradil Aerolizer)

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Why does the client need to shake the inhaler before each dose?

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Because the drug separates easily.

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Why should the client not exhale into the inhaler device?

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This will cause drug clumping.

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What is a cholinergic antagonist?

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It is an anticholinergic agent.

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What does a cholinergic antagonist do? What does it cause?

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It blocks the parasympathetic nervous system which results in bronchodilation & decreased mucus production.

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What side effects can occur with the use of cholinergic antagonists?

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dry mouth/throat, GI distress, headache, coughing & anxiety

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Name a cholinergic antagonist that is commonly used for asthma, but is also used for COPD. Is this agent long or short-acting.

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Ipratopium (Atrovert)
short-acting.

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Name a long-acting cholinergic antagonist agent that is used once a day.

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Tiotropium.

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Name a cholinergic antagonist agent that is a combination of albuterol & atrovent.

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Combivent.

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Client teaching regarding cholinergenic antagonist agent use includes:

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Increase fluid intake & Report blurred vision, eye pain, headache, nausea, nervousness, or palpitations.

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Methylxanthines a.k.a.?

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xanthine derivatives

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When are methylxanthines used?

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When other agents are ineffective to relax smooth muscles of the respiratory tract.

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What are methylxanthines used to treat?

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asthma, chronic bronchitis, emphysema, & bronchospasm.

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Name possible side effects of methylxanthines.

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excessive cardiac and CNS stimulation.

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What are methylxanthines contraindicated for?

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allergy, uncontrolled cardiac dysrhythmias & seizure disorders.

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What is the method of delivery for methylxanthines?

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systemically by oral or parenteral route.

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Name some priority interventions for long-term use of methylxanthines?

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Need to monitor blood levels because they have a narrow therapeutic range. Observe for toxicities esp. w/parenteral administration. RN should be assigned to client since frequent assessments will need to be performed.

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What are s/s of toxicity w/methylxanthines?

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restlessness, insomnia, irritability, tremors, & N/V

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What agents can enhance metabolism of xanthines?

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cigarettes & St. John's Wort

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What might happen if the client quits smoking during xanthine therapy?

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The dose could be to high and may need to be reduced.

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What meds can cause an increase in drug levels of xanthine?

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allopurinol, cimetidine, erythromycin, flue vaccine, & oral contraceptives

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Why is xanthine given w/ caution in elderly clients?

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They tend to have decreased drug metabolism. Be sure to observe for toxicity.

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What should client teaching include for xanthines?

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Take med at same time each day.

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Name the classic drug in the methylxanthine class.

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theophylline (Theo-Dur)

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Name some drugs (other than the classic one) in the methylxanthine class. [per v.s.-these parenteral meds are used to treat bronchospasms.

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aminophylline (Truphylline); oxtriphylline (Choledyl); & diphylline (Dilor, Lufyllin)

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What are anti-inflammatory agents used for?

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To decrease the inflammatory responses in the airways.

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What does the anti-inflammatory class consist of? includes what delivery methods?

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corticosteroids; inhaled anti-inflammatory agents; mast cell stabilizers; monoclonal antibodies; & leukotriene antagonists. systemic and inhalants

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What do corticosteroids do?

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Decrease inflammatory and immune response by preventing mediator synthesis.

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What problems can a client have with the use of inhaled corticosteroids? What is an appropriate intervention to teach the client?

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Increased risk of oral infections. Teach the client to rinse mouth after administration to prevent fungal infections.

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How often are short-term corticosteroid inhalers used?

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frequently

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How often are long-acting corticosteroid inhalers used?

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Once a day

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Name some short-term corticosteroid inhalers.

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Beclomethasone (Vanceril); Triamcinolone (Azmacort); & Flunisolide (AeroBid)

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Name some long-acting once a day corticosteroid inhalers.

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Budesonide (Pulmocort); & Fluticasone (Flovent)